European Radiology

, Volume 27, Issue 12, pp 5280–5289 | Cite as

Impact of perfusion lesion in corticospinal tract on response to reperfusion

  • Ying Zhou
  • Ruiting Zhang
  • Sheng Zhang
  • Shenqiang Yan
  • Ze Wang
  • Bruce C. V. Campbell
  • David S. Liebeskind
  • Min LouEmail author
Magnetic Resonance



We aimed to examine the impact of corticospinal tract (CST) involvement in acute ischaemic stroke (AIS) patients on functional outcome and the interaction with reperfusion.


We retrospectively examined data in consecutive anterior circulation AIS patients undergoing thrombolysis. MR perfusion (time to maximum of tissue residue function, Tmax) and apparent diffusion coefficient (ADC) images were transformed into standard space and the volumes of CST involvement by Tmax > 6 s (CST-Tmax) and ADC < 620 × 10−6 mm2/s (CST-ADC) lesions were calculated. Good outcome was defined as modified Rankin scale ≤ 2 at 3 months. Reperfusion was defined as a reduction in Tmax > 6 s lesion volume of ≥70% between baseline and 24 h.


82 patients were included. Binary logistic regression revealed that both CST-Tmax and CST-ADC volume at baseline were significantly associated with poor outcome (p < 0.05). The 24-h CST-ADC volume was correlated with baseline CST-ADC volume in patients with reperfusion (r = 0.79, p < 0.001) and baseline CST-Tmax volume in patients without reperfusion (r = 0.67, p < 0.001). In patients with CST-Tmax volume > 0 mL and CST-ADC volume < 3 mL, the rate of good outcome was higher in patients with reperfusion than those without (70.4% vs 38.1%, p = 0.04).


The use of CST-Tmax in combination with CST-ADC provides prognostic information in patients considered for reperfusion therapies.

Key Points

• Examine the impact of corticospinal tract involvement in acute ischaemic stroke patients.

• Spatially registered Tmax images can identify corticospinal tract hypoperfusion injury.

• Corticospinal tract salvage through reperfusion is associated with improved outcome.


Stroke Thrombolytic therapy Magnetic resonance imaging Prognosis Corticospinal tract 



Apparent diffusion coefficient


Arterial input function


Acute ischaemic stroke


Confidence interval


Corticospinal tract reperfusion rate


Corticospinal tract


Volumes of corticospinal tract involvement by apparent diffusion coefficient < 620 × 10−6 mm2/s


Volumes of corticospinal tract involvement by time to maximum of tissue residue function > 6 s


Diffusion tensor imaging


Diffusion-weighted imaging


Haemorrhage transformation


Montreal Neurology Institute


Motor subscore of the National Institute of Health Stroke Scale


Modified Rankin scale


Magnetic resonance perfusion


National Institute of Health Stroke Scale


Odds ratio


Receiver operating characteristic


Reperfusion rate


Recombinant tissue-type plasminogen activator


Singular value deconvolution


Symptomatic haemorrhage transformation


T1-weighted imaging


Time to maximum of tissue residue function



We are grateful for the support from our patients.

Compliance with ethical standards


The scientific guarantor of this publication is Min Lou.

Conflict of interest

The authors of this manuscript declare relationships with the following companies: Dr. Liebeskind is among the consultant/advisory board (modest) of Stryker and Covidien. Other authors have no actual or potential conflicts of interest to disclose.


This study has received funding by the National Natural Science Foundation of China (81622017 & 81471170) and the National Key Research and Development Program of China (2016YFC1301500).

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional review board approval was obtained.


• retrospective

• observational

• performed at one institution

Supplementary material

330_2017_4868_MOESM1_ESM.docx (17 kb)
ESM 1 (DOCX 17 kb)


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Copyright information

© European Society of Radiology 2017

Authors and Affiliations

  • Ying Zhou
    • 1
  • Ruiting Zhang
    • 1
  • Sheng Zhang
    • 1
  • Shenqiang Yan
    • 1
  • Ze Wang
    • 2
    • 3
    • 4
  • Bruce C. V. Campbell
    • 5
  • David S. Liebeskind
    • 6
  • Min Lou
    • 1
    Email author
  1. 1.Department of Neurologythe Second Affiliated Hospital of Zhejiang University, School of MedicineHangzhouChina
  2. 2.Center for Cognition and Brain Disorders, Institutes of Neurological ScienceHangzhou Normal UniversityHangzhouChina
  3. 3.Affiliated Hospital of Hangzhou Normal UniversityHangzhouChina
  4. 4.Zhejiang Key Laboratory for Research in Assessment of Cognitive ImpairmentsHangzhouChina
  5. 5.Department of Medicine and Neurology, Royal Melbourne HospitalUniversity of MelbourneParkvilleAustralia
  6. 6.Los Angeles Stroke Center, University of CaliforniaLos AngelesUSA

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